MEDICARE: JOSEPHSON WALLACK MUNSHOWER NEUROLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ9849	OTHER		MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740377803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPHSON WALLACK MUNSHOWER NEUROLOGY PC

Provider Business Mailing Address
First Line	:	PO BOX 2152
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46206-2152
Country	:	US
Telephone Number	:	317-308-2800
Fax Number	:	317-576-6311

Provider Business Practice Location Address
First Line	:	6983 HILLSDALE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2054
Country	:	US
Telephone Number	:	317-308-2800
Fax Number	:	317-576-6311

Authorized Official
Title or Position	:	CFO/CIO
Name	:	SUSAN MATTOX
Credential	:
Telephone Number	:	317-308-2800

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	05/09/2025

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